单纯性肥胖儿童血清内脂素与促炎因子的相关性

The relationship between visfatin and proinflammatory factors in children with simple obesity

目的探讨单纯性肥胖儿童血清内脂素(visfatin)水平的变化及其与炎症标志物和糖脂代谢参数的相关性。方法选择2009年6月至2011年2月在武汉儿童医院门诊就诊、符合单纯性肥胖诊断标准的肥胖儿童44例(男23例,女21例),同时选择门诊体检的年龄、性别相匹配的正常体质量儿童50例(男23例,女27例)为健康对照组。指派专人进行完整的体格检查,包括人体测量参数(身高、体质量、腰围和血压),测定空腹血清visfatin、高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、血糖、胰岛素和血脂水平,采用SPSS 15.0软件进行统计分析。结果1.肥胖组儿童血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)均明显高于健康对照组(均P<0.05),而血清高密度脂蛋白胆固醇(HDL-C)均明显低于健康对照组(均P<0.01);肥胖组儿童空腹血糖、空腹胰岛素、胰岛素敏感性指数(HOMA-IR)均明显高于健康对照组(均P<0.01)。2.肥胖儿童血清visfatin、hs-CRP和IL-6水平均明显高于健康对照组,差异均有统计学意义(均P<0.05);肥胖儿童血清TNF-α水平与健康对照组比较差异无统计学意义(P>0.05)。3.肥胖儿童血清visfatin水平与体质量指数(BMI)(r=0.218,P<0.05)、腰围(r=0.332,P<0.05)、TG(r=0.283,P<0.01)均呈正相关;与IL-6(r=0.376,P<0.05)、hs-CRP(r=0.321,P<0.05)均呈正相关;与空腹血糖、空腹胰岛素和HOMA-IR均无相关性;与TNF-α亦无相关性(r=0.085,P>0.05)。4.visfatin与人体测量、代谢参数和炎性因子之间的相关性存在性别差异。visfatin在男童和女童中均与腰围、TG和hs-CRP呈正相关,但仅与男童的BMI(r=0.247,P=0.029)和IL-6(r=0.427,P=0.013)呈正相关。结论肥胖儿童存在明显的糖脂代谢紊乱和胰岛素抵抗。visfatin作为一种内脏脂肪因子,具有调节糖脂代谢和促炎的双层作用,可能参与肥胖相关的代谢紊乱及炎症反应。检测肥胖儿童血清visfatin水平可作为反映机体低水平炎症反应新的炎症标志物之一。

Objective To investigate the change of serum visfatin concentration in simple obese children and its correlation with inflammatory markers,glucose and lipid parameters.Methods A total of 44 obese children(23 males,21 females)who met the diagnostic criteria of simple obesity were selected,and 50 age-and gender-matched normal weight children(23 males,27 females)were used as the healthy controls.A complete physical examination,including anthropometric parameters(height,body mass,waist circumference and blood pressure),was carried out by a specially assigned person.The fasting serum levels of visfatin,high sensitivity C-reactive protein(hs-CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,blood glucose,insulin and blood lipid were measured and analyzed by SPSS 15.0 software.Results(1)The serum levels of total cholesterol(TC),triacylglycerol(TG)and low density lipoprotein-cholesterol(LDL-C)of obese children were significantly higher than those of healthy children(all P<0.05),while the serum high density lipoprotein cholesterol(HDL-C)level was significantly lower than that of healthy children(all P<0.01).The fasting blood glucose level,fasting insulin level and the value of homeostatic model assessment of insulin resistance(HOMA-IR)of obese children were significantly higher than those of healthy children(P<0.01).(2)The serum levels of visfatin,hs-CRP and IL-6 in obese children were significantly higher than those in the healthy control group(all P<0.05);there was no significant difference between the serum levels of TNF-αin obese children and the healthy control group(P>0.05).(3)The serum visfatin level was significantly positively correlated with body mass index(BMI)(r=0.218,P<0.05),waist circumference(r=0.332,P<0.05),TG(r=0.283,P<0.01),IL-6(r=0.376,P<0.05),and hs-CRP(r=0.321,P<0.05),but not significantly correlated with fasting blood glucose,fasting insulin,HOMA-IR,and TNF-α(r=0.085,P>0.05).(4)There were gender differences in the correlation of visfatin with anthropometric parameters,metabolic parameters and inflammatory factors.Visfatin were positively correlated with waist circumference,TG and hs-CRP in both boys and girls,but only positively correlated with BMI(r=0.247,P=0.029)and IL-6(r=0.427,P=0.013)in boys.Conclusions Obese children have obvious disorders of glucose and lipid metabolism and insulin resistance.Visfatin,as a visceral adipokine,has double functions of regulating glucose and lipid metabolism and promoting inflammation.It may be involved in obesity related metabolic disorders and inflammation.The detection of serum visfatin in obese children can be used as a new inflammatory marker to reflect the low level of inflammatory response.